当归黄芪汤联合雷公藤多苷治疗糖尿病肾病临床疗效的Meta分析

Meta-Analysis of the Clinical Efficacy of Angelica Sinensis Astragalus Decoction Combined with Tripterygium Wilfordii Polyglycosides in the Treatment of Diabetic Nephropathy

摘要: 目的：系统评价当归黄芪汤联合雷公藤多苷治疗糖尿病肾病(DKD)的临床疗效，为治疗DKD提供参考。方法：通过计算机检索VIP、Wan Fang Data、CNKI中文数据库以及PubMed，Cochrane，Web of Science图书馆外文数据库，收集关于当归黄芪汤联合雷公藤多苷治疗DKD临床随机(RCT)和半随机对照实验。检索时限均从建库到2025年3月1日。由2位研究者独立筛选文献、提取资料以及采用Cochrane进行风险评估及进行方法学质量评价后，运用RevMan 5.3和Stata16.0软件对提取的数据进行Meta分析。结果：纳入12篇文献，总共1030例DKD患者，其中治疗组516例，对照组514例。Meta分析结果显示，当归黄芪汤联合雷公藤多苷治疗糖尿病肾病的总有效率高于对照组[OR = 4.40, 95% CI (2.94, 6.60), Z = 7.18, P < 0.00001]。当归黄芪汤联合雷公藤多苷在降低24 h尿蛋白[SMD = −3.66, 95% CI (−4.68, −2.65), Z = 7.08, P < 0.00001]、[SMD = −2.55, 95% CI (−3.07, −2.02), Z = 9.51, P < 0.00001]；减轻降低血白蛋白[SMD = 1.08, 95% CI (0.62, 1.53), Z = 4.66, P < 0.00001] [SMD = 1.47, 95% CI (1.23, 1.70), Z = 12.18, P < 0.00001]；降低三酰甘油[SMD = −2.38, 95% CI (−4.11, −0.65), Z = 2.70, P = 0.007]、[SMD = −2.45, 95% CI (−2.92, 1.97), Z = 10.06, P < 0.00001]方面都优于对照组。治疗组和对照组在控制尿素氮、血肌酐水平方面差异无统计学意义。结论：当归黄芪汤联合雷公藤多苷治疗糖尿病肾病的总有效率高于常规西医治疗，可以更好地改善DKD患者的蛋白尿、血浆白蛋白水平、降低三酰甘油，明显改善肾功能(肾小球滤过率、血浆白蛋白)指标，对尿素氮、血肌酐指标没有明显的影响。

Abstract: Objective: To systematically evaluate the clinical efficacy of Angelica sinensis astragalus decoction combined with tripterygium wilfordii polyglycosides in the treatment of diabetic nephropathy (DKD), and to provide reference for the treatment of DKD. Methods: Randomized (RCT) and quasi-randomized controlled trials of Angelica astragalus decoction combined with tripterygium wilfordii polyglycosides in the treatment of DKD were collected by computer search of VIP, Wan Fang Data, CNKI Chinese database and foreign language databases of PubMed, Cochrane and Web of Science libraries. The search time period was from the inception of the database to March 1, 2025. Two review authors independently screened the literature, extracted data, and used Cochrane to conduct risk assessment and methodological quality assessment, and then used RevMan 5.3 and Stata 16.0 software to meta-analyze the extracted data. Results: A total of 1030 patients with DKD were included in 12 studies, including 516 in the treatment group and 514 in the control group. The results of meta-analysis showed that the total effective rate of Angelica astragalus decoction combined with tripterygium wilfordii polyglycosides in the treatment of diabetic nephropathy was higher than that in the control group [OR = 4.40, 95% CI (2.94, 6.60), Z = 7.18, P < 0.00001]. Angelica astragalus decoction combined with tripterygium wilfordii polyglycosides reduced 24-hour urine protein [SMD = −3.66, 95% CI (−4.68, −2.65), Z = 7.08, P < 0.00001], [SMD = −2.55, 95% CI (−3.07, −2.02), Z = 9.51, P < 0.00001]; Reduced albumin [SMD = 1.08, 95% CI (0.62, 1.53), Z = 4.66, P < 0.00001] [SMD = 1.47, 95% CI (1.23, 1.70), Z = 12.18, P < 0.00001]; Reduced triacylglycerol [SMD = −2.38, 95% CI (−4.11, −0.65), Z = 2.70, P = 0.007] and [SMD = −2.45, 95% CI (−2.92, 1.97), Z = 10.06, P < 0.00001]. were superior to the control group. There was no significant difference between the treatment group and the control group in controlling urea nitrogen and serum creatinine levels. Conclusion: The total effective rate of Angelica astragalus decoction combined with tripterygium wilfordii polyglycosides in the treatment of diabetic nephropathy is higher than that of conventional Western medicine, and can better improve proteinuria, plasma albumin levels, triacylglycerol and renal function (glomerular filtration rate, plasma albumin) in patients with DKD, but has no significant effect on urea nitrogen and serum creatinine indicators.